Healthcare Provider Details

I. General information

NPI: 1689746893
Provider Name (Legal Business Name): AUDREY WILLETTE HOLLAR RN,CLNC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 FRONT ROYAL PIKE STE 200
WINCHESTER VA
22602-4324
US

IV. Provider business mailing address

117 LIKENS WAY
WINCHESTER VA
22602-7636
US

V. Phone/Fax

Practice location:
  • Phone: 540-667-2809
  • Fax: 540-678-9518
Mailing address:
  • Phone: 540-723-0280
  • Fax: 540-723-6698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number0001117631
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: